Embolic Strokes of Undetermined Source in the Athens Stroke Registry: A Descriptive Analysis | Journal Scan

Nov 24, 2014
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Authors:
Ntaiok G, Papvasileiou V, Milionis H, et al.
Citation:
Stroke 2014;Nov 6:[Epub ahead of print].
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Study Questions:

What is the population of patients who experience embolic stroke of undetermined source (ESUS)?

Methods:

Using the Athens Stroke Registry of patients with a first-ever stroke, the authors described all patients who met the Cryptogenic Stroke/ESUS International Working Group definition of ESUS. ESUS is defined as a radiologically confirmed non-lacunar infarct of the brain without intra-/extra-cranial atherosclerosis (≥50%), no major-risk cardioembolic source, and no other specific cause of stroke. All patients underwent electrocardiogram (ECG) at admission and some had continuous monitoring during the hospitalization. Some patients used 24-hour Holter monitors after hospital discharge or underwent repeat ECG monitoring after hospital discharge.

Results:

Of the 2,735 patients in the registry between 1992 and 2011, 275 (10.0%) were classified as ESUS. Median age was 68 years (interquartile range, 58-76 years) and 64.0% were male. Most patients (74.2%) had maximal symptoms at the time of onset. ESUS were usually of moderate severity (median National Institutes of Health Stroke Scale [NIHSS] score of 5), similar to large artery atherosclerotic stroke, but less than cardioembolic strokes (median NIHSS 13). The most common risk factors were hypertension (64.7%) and dyslipidemia (50.9%). Among potential causes, covert atrial fibrillation (AF) was the most prevalent (10.9%), usually diagnosed during hospitalization for stroke recurrence or during repeat ECG at a follow-up visit.

Conclusions:

The authors concluded that about 10% of patients with a first-ever stroke met criteria for ESUS, and that covert AF is a frequent cause.

Perspective:

The authors concluded that about 10% of patients with a first-ever stroke met criteria for ESUS, and that covert AF is a frequent cause.

Keywords: Anticoagulants, Stroke, Atrial Fibrillation, Brain, Dyslipidemias, Electrocardiography, Hospitalization, Hypertension, Risk Factors, Registries


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